Datica Podcast

September 29, 2017

Dan Munro: Healthcare’s Technology Gamble

Dan Munro - Casino Healthcare book

On why the U.S. health system feels like a casino: “We don't really know what it is going to cost. We don't know what the diagnosis will be. We don't know what the outcome will be. And even beyond these big risks, there is clinical evidence that many of the most expensive conditions to treat, ones like cancer, are the ones that are the result of totally random cell mutation. That happens about 66% of the time.”

On whether a universal or national patient identifier is on the horizon: “Yeah, there's no system that is perfectly safe but we can do a lot better than social security numbers in the status quo. Other countries are already doing this today. In my own view, patient safety should always trump consumer ignorance of this issue, but it often doesn't. Most consumers don't understand the risk at all because they don't have to access these systems. But about 10 to 14 percent of medical errors are the result of mismatched patient identification.”

“I think we are headed towards an inevitability of patient identification and I also think that it's going to need to be a government mandate, in much the same way that the government mandates things like vehicle identification numbers, the government mandated AC outlets. The government mandates train track gauges for these very reasons, because there's a safety component to each of those and that's the same thing we are going to come across with healthcare.”

On how dire the patient matching statistics have become: “Very acute. In fact the statistics I saw are that within a hospital system, patient matching using algorithms and other current techniques can really get the accuracy to a pretty high level in the mid to high 90s. The problem occurs rapidly when you try and share that data outside of the hospital and in those cases where data is being shared outside of the hospital, patient matching accuracy drops into the low 50s to 60 percent.”

On the history and political aspects of the national patient identifier: “In fact the interesting history to it is that a national patient identifier was actually baked into the first iteration of HIPAA, which is portability. So there were two components of HIPAA that are often forgotten. The first is that it was designed to create a national provider identifier and it was also tasked to create a national patient identifier. We kept the provider identifier and in fact that's still in use today. So we have a national provider identifier but for political and financial reasons, it was deemed to be too sensitive to create a national patient identifier. So they punted on funding that.”

On the difference between “universal healthcare” and “universal coverage: “We tend to lump the phrase in with medicare for all, single payer and universal healthcare. The reality is it is distinctly separate. Universal coverage is the right term and is the term that is identified by the World Health Organization. Their definition is pretty good, which is that all people have access to preventative, curative and rehabilitative health services of sufficient quality to be effective while also ensuring that people do not suffer financial hardship when paying for these services. That's in a nutshell. Now, how you pay for that is what the debate ahead is focused on.”

On why the U.S. has a tiered system for healthcare payments: “If you think about it, the tiering starts with age. We tier by age twice, by age 26 and age 65. We also tier by employment — employer-sponsored insurance. We tier by military service, which is the VA. We tier by heritage, which is the Indian Health Services. We tier by income, which is Medicaid. So we have all these tiers of coverage and even after all those tiers, we still wind up with about 10 percent of the American population that are concerned uninsured. We have eight tiers and then some smaller tiers on top of those and you have to ask yourself, so why do we do this tiering? The only reason that we do tiering in the sense of coverage is to support tiered pricing. It's the tiered pricing is really at the heart of a system that has been optimized for revenue and profits and not safety and quality.”